Author Information

Roozbeh Sharif,

Adnan Khan,

Sangeeta Mutnuri,

Joseph Stafford,

Gyanendra K. Acharya,

Anjali Kohli,

Mohamed Morsy,

Yong-Fang Kuo and

Wissam Khalife

Background

Diabetes mellitus (DM) is a risk factor for left ventricular diastolic dysfunction (LVDD). However, the impact of glycemic control and type of medical therapy on the development of the LVDD with preserved ejection fraction in patients with DM remains unclear.

Methods

In a cross-sectional study, we reviewed the medical records of patients who presented to the echocardiographic lab in a tertiary care academic center between 2008 and 2011. Patients with ejection fraction ≥ 50% were included. Diastolic function was assessed based on the echocardiographic characteristics. Serum glycosylated hemoglobin (HbA1c) < 7 was considered as controlled DM. Medication history ±90 days of echo date was obtained. Frequency of LVDD among those with uncontrolled DM was compared to those with controlled DM as well as those without DM. Using logistic regression analysis, the association between serum HbA1c and LVDD was investigated after adjusting for potential demographic and clinical confounders. Then, we hypothesized that type of diabetes control medications (Insulin therapy vs oral agents) might modify this association and examined the interaction term of type of treatment in regards to the association between diabetes control (serum HbA1c level) and

LVDD.

Results

Among 788 patients enrolled in the study, 49.9% were females and 50.1% were non-Hispanic whites. Among 603 patients with DM, 385 had un-controlled DM (HgbA1>7). LVDD was reported more frequently among patients with uncontrolled DM, compared to those with controlled DM and normal controls (89.9% vs. 56.0% and 48.7%, p<0.0001). The multivariable analysis indicated that serum HgbA1c level was associated with presence of LVDD, after adjustment for age, gender, CKD stages among patients with DM (OR: 2.02, 95%CI 1.64-2.49, p<0.0001). There was no difference of LVDD between patients with controlled DM and those without history of DM (OR: 1.22, 95%CI: 0.79-1.86). The analysis of potential effect modifier indicated there was no significant interaction between HbA1c and type of treatments with LVDD (p=0.7900).

Conclusions

Tight glycemic control in patients with diabetes mellitus decreases the risk of LVDD regardless of the type of treatment.

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